Myocardial Native T1 Mapping in the German National Cohort (NAKO): Associations with Age, Sex, and Cardiometabolic Risk Factors.
Authors
Affiliations (20)
Affiliations (20)
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Working Group on CMR, Experimental and Clinical Research Center, a cooperation between Charité - Universitätsmedizin Berlin and the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Working Group on CMR, Experimental and Clinical Research Center, a cooperation between Charité - Universitätsmedizin Berlin and the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Deutsches Herzzentrum der Charité - Medical Heart Center of Charité and German Heart Institute Berlin, Department of Cardiology, Angiology and Intensive Care, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Working Group on CMR, Experimental and Clinical Research Center, a cooperation between Charité - Universitätsmedizin Berlin and the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany.
- Department of Diagnostic and Interventional Radiology, University of Freiburg, Freiburg, Germany.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Working Group on CMR, Experimental and Clinical Research Center, a cooperation between Charité - Universitätsmedizin Berlin and the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.
- Berlin Ultrahigh Field Facility, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.
- Department of Nephrology, University Medical Centre Freiburg, Freiburg, Germany.
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
- German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Division of Primary Cancer Prevention, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany.
- Medical Image and Data Analysis (MIDAS.Lab), University Hospital of Tübingen, Tübingen, Germany.
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Tübingen, Germany.
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany.
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany.
- Institute of Community Medicine (SHIP/KEF), University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner Site Greifswald, Greifswald, Germany.
- German Centre for Cardiovascular Research (DZHK), partner Site Greifswald, Greifswald, Germany; Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; Biobank Technology Platform, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Working Group on CMR, Experimental and Clinical Research Center, a cooperation between Charité - Universitätsmedizin Berlin and the Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Department of Cardiology and Nephrology, HELIOS Hospital Berlin-Buch, Berlin, Germany. Electronic address: [email protected].
Abstract
In cardiovascular magnetic resonance (CMR), myocardial native T<sub>1</sub> mapping enables quantitative, non-invasive tissue characterization and is sensitive to subclinical changes in myocardial structure and composition. However, data on the association between cardiometabolic risk and myocardial alterations are still limited. We therefore investigated how age, sex, and cardiometabolic risk factors are associated with myocardial T<sub>1</sub> as a potential imaging marker of myocardial target-organ involvement in a population-based analysis within the German National Cohort (NAKO). This cross-sectional study included 29,573 prospectively enrolled participants who underwent midventricular T<sub>1</sub> mapping using 3.0T CMR along with deep clinical phenotyping. After artificial intelligence-assisted myocardial segmentation, a subset of 9,162 outlier cases was subjected to manual quality control according to clinical evaluation standards. Cardiometabolic risk factors were identified through self-reported, physician-diagnosed medical history, clinical chemistry, and blood pressure measurements. Associations with myocardial T<sub>1</sub> were evaluated using multiple linear regression models adjusted for age, sex, heart rate, imaging site, and comorbidities. After quality control, 27,794 participants (12,401 [44.6%] women; 20-75 years) were included. Mean T<sub>1</sub> was overall higher in women (1,231 ± 33 ms) than in men (1,209 ± 34 ms), with differences progressively declining with age. The sex difference was confirmed in a healthy subcohort (n = 3,910), whilst age interaction was less pronounced. In adjusted analyses, T<sub>1</sub> was significantly higher in individuals with diabetes, kidney disease, and current smoking. Conversely, hyperlipidaemia was significantly associated with lower T<sub>1</sub>. Associations with hypertension showed strongly sex-specific patterns: women had lower T<sub>1</sub> values, while T<sub>1</sub> increased with hypertension severity in men. Myocardial native T<sub>1</sub> varies by sex and age and shows distinct sex-specific associations with major cardiometabolic risk factors, supporting its role as a sensitive imaging marker of subtle myocardial alterations. Unexpectedly lower T<sub>1</sub> times in participants with hyperlipidaemia suggest a potential direct effect of blood lipids on the heart, which warrants further investigation.